Facts about Hodgkin Lymphoma

Understanding Hodgkin Lymphoma

Hodgkin lymphoma is caused when something goes wrong inside the lymphocytes, which are a type of white blood cell made in the bone marrow and found in the blood and lymph tissue.

Usually, healthy lymphocytes help our bodies fight infection. In lymphoma, the lymphocytes don’t mature and can’t do their normal immune functions to defend against infection. The lymphoma cells don’t die off like they should. Instead, they collect in the lymph nodes.

There are several kinds of lymphocytes that protect the body in many ways:

  • B lymphocytes, or B cells, make antibodies. Antibodies attach to bacteria and to cells that are infected with a virus or bacteria, so that other immune cells recognize them and know to destroy them.

  • T lymphocytes, or T cells, help destroy invaders or tumor cells and attract or stimulate other immune cells to kill invaders.

  • Natural killer cells search for abnormal cells and destroy them.

Most often, Hodgkin lymphoma starts in the lymph nodes in the upper part of the body — in the neck or chest or under the arms. It can spread through the lymph system to nearby lymph nodes and outside the lymph nodes to the bone marrow, lungs or liver. The good news: Hodgkin lymphoma can be cured or controlled for many years in most people who have the disease.

The Lymph System

To understand lymphoma, it helps to know the basics about your lymph system. The lymph system is a network of tubes (lymphatic vessels) that slowly carry fluid from your tissues into your bloodstream to be recycled. This fluid (lymph) contains waste products from body tissues as well as immune system cells.
An important part of your immune system, lymph nodes are small, bean-shaped organs linked by your lymphatic vessels. They store lymphocytes and act as filters to trap foreign particles.

Lymph nodes are located throughout your body in your neck, underarms, groin and behind your knees. They are also deeper inside your body in your chest, abdomen and pelvic area. Along with lymph nodes, you have other lymph tissue, including organs related to your immune and blood-forming systems, such as your spleen, thymus and bone marrow.

What Causes Hodgkin Lymphoma?

About 8,300 people are newly diagnosed with Hodgkin lymphoma in the United States each year. Physicians do not know what causes Hodgkin lymphoma. It is more common in men than in women and more common in people ages 15 to 35 or over 50.

You may be at higher risk if any of these is true:

  • Your immune system is weakened by an inherited disease, an autoimmune disease, human immunodeficiency virus (HIV) or drugs that you are taking because you had an organ transplant.
  • You have been infected with Epstein-Barr virus (which causes mononucleosis).
  • Your brother or sister had Hodgkin lymphoma.

However, keep in mind that most people who get the disease do not have any of these risk factors, and most people with these risk factors do not develop the disease.


lymph nodes

Learn About Subtypes

Each of the two types of Hodgkin lymphoma, and their subtypes, acts differently. Fred Hutch physicians have deep knowledge of these subtypes, and they know which therapies to use and when to use them.  

Hodgkin lymphoma specialists at Fred Hutch see hundreds of patients every year, year after year, so they are very experienced with every type and subtype of this disease.

There are two main types of Hodgkin lymphoma:

Classic Hodgkin Lymphoma

In classic Hodgkin lymphoma (cHL), which is about 95 percent of Hodgkin lymphoma cases, there are four subtypes. These subtypes are named for what’s happening to the lymph nodes and which kinds of immune-system cells are involved along with Reed-Sternberg cells:

  • Nodular sclerosis
  • Mixed cellularity
  • Lymphocyte-rich
  • Lymphocyte-depleted

Nodular Lymphocyte-Predominant Hodgkin Lymphoma

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare type of Hodgkin lymphoma, which is only 5 percent of cases. It tends to grow more slowly than classic Hodgkin lymphoma. This type involves nodules made up of lymphocytes and a type of Reed-Sternberg cells, sometimes called “popcorn” cells because of how they look. Over time, about 10 percent of these lymphomas turn into aggressive diffuse B-cell lymphoma, which is a type of non-Hodgkin lymphoma. For people who have early-stage NLPHL without any B symptoms, involved-site radiation therapy is often all that's needed.

Types of Treatment for Hodgkin Lymphoma

Today, there are more treatment options for Hodgkin lymphoma than ever before. Physicians are better able to control the disease or put it into remission, even if the disease is advanced.

Staging Hodgkin Lymphoma

Staging means finding out how far Hodgkin lymphoma has spread in your lymph system or other parts of your body. This helps your physicians predict which treatments are most likely to control your disease or put it into remission. 

Physicians use Roman numerals I (one), II (two), III (three) and IV (four) to name the stages of Hodgkin lymphoma. Stage I is the least advanced, and stage IV is the most advanced. All stages can be treated, and even advanced Hodgkin lymphoma can often be put into remission.

  • Stage I: Cancer is only in one group of lymph nodes or is only in one place outside your lymph system.
  • Stage II: Cancer is in two or more groups of lymph nodes, both above or both below your diaphragm. Cancer can also be in one organ and in lymph nodes in the same area (it can also be in other lymph nodes on the same side of your diaphragm).
  • Stage III: Cancer is in lymph nodes on both sides of your diaphragm.
  • Stage IV: Cancer has spread beyond your lymph nodes to other parts of your body, like your bone marrow, lungs or liver.

Physicians may also add a letter after your stage to describe more about your disease.

  • A (as in “stage IA”) means you do not have symptoms.
  • B (as in “stage IB”) means you have B symptoms: fever, weight loss or night sweats.
  • E (as in “stage IIIE”) means your cancer is outside your lymph system (extranodal).
  • S (as in “stage IIIS”) means the cancer is in your spleen.

To understand your lymphoma and recommend the best treatment for you, your physician will think about many things, such as whether you have:

  • A tumor in your chest bigger than a certain size
  • Cancer in an organ other than your lymph nodes
  • Three or more lymph nodes with cancer
  • A high sedimentation rate (your red blood cells settle quickly to the bottom of a test tube in a sample of your blood)
  • Certain levels of blood albumin, hemoglobin, white blood cells and lymphocytes

If your lymphoma comes back after treatment, it is called recurrent or relapsed. Your physician will ask for imaging tests or other tests to restage it. After restaging, your physician will work with you to make a new personalized treatment plan for your situation.

Staging Tests

To diagnose the stage of your Hodgkin lymphoma, you need imaging and blood tests. 

Imaging tests show which lymph nodes are bigger than normal, if other organs are affected and if you have any large tumors.

Blood tests check for lymphoma cells in your blood. They also check for other substances (like proteins) that can tell physicians how serious your disease is, if your organs are working well and how urgently you need treatment.

You will probably also have tests to check if lymphoma is in your bone marrow.

Imaging Tests

Imaging tests to stage Hodgkin lymphoma may include one or more of the following : 

  • Chest X-ray
  • CT (computed tomography) scan
  • PET (positron emission tomography) scan
  • MRI (magnetic resonance imaging)
  • Ultrasound

Blood Tests

Blood tests to stage Hodgkin lymphoma may include: 

  • Complete blood count (CBC)
  • Comprehensive metabolic panel 

Bone Marrow Aspiration and Biopsy

After numbing the area so there is no pain, a physician uses a hollow needle to take a sample of marrow (bone marrow aspiration) and a small piece of bone (bone marrow biopsy). A pathologist checks these samples for signs of cancer.

Other Tests You Might Need

If you have lymphoma, you may need more tests to identify the type. These can include:

  • An immunohistochemistry study
  • Immunophenotyping, or flow cytometry
  • Cytogenetic analysis

Fred Hutch has researched and treated Hodgkin Lymphoma for decades.


There are many resources online for learning about your disease. Health educators at the Fred Hutch Patient and Family Resource Center have compiled a list of trusted sources to help you get started.

Whether you are newly diagnosed, going through treatment or know someone with cancer, our staff are available to tailor personalized resources and answer questions about support options in the community. 

American Society of Clinical Oncology

American Society of Clinical Oncology (ASCO): Guide to Lymphoma - Hodgkin

This is Cancer.Net's Guide to Hodgkin lymphoma. Here you can learn more about Hodgkin lymphoma, treatment, the latest research and clinical trials.

National Comprehensive Cancer Network

National Comprehensive Cancer Network (NCCN) Guidelines for Patients: Hodgkin Lymphoma

This step-by-step guide to the latest advances in cancer care features questions to ask your physician, patient-friendly illustrations and glossaries of terms and acronyms.